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ethinyl estradiol and norelgestromin (transdermal)

Generic Name: ethinyl estradiol and norelgestromin (transdermal) (EH thi nil ESS tra DYE ol and nor ell JESS tro min)
Brand Name: Xulane, Ortho Evra

What is ethinyl estradiol and norelgestromin transdermal?

Ethinyl estradiol and norelgestromin contains a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medicine also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and norelgestromin transdermal (skin patch) is used as contraception to prevent pregnancy.

Ethinyl estradiol and norelgestromin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ethinyl estradiol and norelgestromin transdermal?

Do not use this medicine if you are pregnant or if you have recently had a baby.

You should not use hormonal birth control if you have: uncontrolled high blood pressure, heart disease, coronary artery disease, circulation problems (especially with diabetes), undiagnosed vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you also take certain hepatitis C medication, if you have major surgery, if you smoke and are over 35, or if you have ever had a heart attack, a stroke, a blood clot, jaundice caused by pregnancy or birth control pills, or cancer of the breast, uterus/cervix, or vagina.

Using hormonal birth control can increase your risk of blood clots, stroke, or heart attack. Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. You should not use this medicine if you smoke and are older than 35 years of age.

What should I discuss with my healthcare provider before using ethinyl estradiol and norelgestromin transdermal?

Using hormonal birth control can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using birth control. Your risk is also high when you restart this medicine after not using for 4 weeks or longer.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not use this medicine if you smoke and are over 35 years old.

Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.

Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant, or if you miss 2 menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before using this medicine.

You should not use hormonal birth control if you have:

  • untreated or uncontrolled high blood pressure;

  • heart disease (chest pain, coronary artery disease, history of heart attack, stroke, or blood clot);

  • an increased risk of having blood clots due to a heart problem or a hereditary blood disorder;

  • circulation problems (especially if caused by diabetes);

  • a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;

  • unusual vaginal bleeding that has not been checked by a doctor;

  • liver disease or cancer;

  • severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35;

  • a history of jaundice caused by pregnancy or birth control pills;

  • if you smoke and are over 35 years old; or

  • if you take any hepatitis C medication containing ombitasvir/paritaprevir/ritonavir (Technivie).

To make sure ethinyl estradiol and norelgestromin is safe for you, tell your doctor if you have ever had:

  • heart problems, high blood pressure, or if you are prone to having blood clots;

  • high cholesterol or triglycerides, or if you are overweight;

  • depression;

  • a seizure or migraine headache;

  • liver or kidney disease;

  • irregular menstrual cycles; or

  • diabetes, gallbladder disease, underactive thyroid.

The hormones in this medicine can pass into breast milk and may harm a nursing baby. This medicine may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use ethinyl estradiol and norelgestromin transdermal?

Follow all directions on your prescription label. You will apply your first patch on the first day of your period or on the first Sunday after your period begins (follow your doctor's instructions).

Do not wear more than one skin patch at a time. Never cut a skin patch.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Apply the patch to clean, dry skin and press it into place firmly for 10 seconds. Make sure the edges stick well and wear the patch for a full week (7 days).

Do not apply the patch to skin that is broken or irritated, or to a skin area that may be rubbed by tight clothing (such as a waistband).

Remove the patch and apply a new one on the same day each week for 3 weeks in a row (21 days). Then remove the patch and do not apply a new one for 7 full days. Your period should start during this time. Do not allow more than 7 days to pass before starting your next 3-week patch cycle.

You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.

If you need major surgery with long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.

While using ethinyl estradiol and norelgestromin transdermal, you will need to visit your doctor regularly.

Check your skin patch every day. If a patch comes loose or falls off, throw it away and apply a new one. You may need to use back-up birth control (condoms with spermicide), if a patch has been off for more than 24 hours. Follow your doctor's instructions.

After removing a skin patch fold it in half, sticky side in, and throw it away in a place where children and pets cannot get to it. Do not flush a used patch down the toilet.

Store the skin patches at room temperature away from moisture and heat. Do not freeze or refrigerate. Keep each patch in its foil pouch until you are ready to apply it.

What happens if I miss a dose?

If you forget to change your patch at the end of the week, change it as soon as you remember. If it has been 24 hours or longer since your scheduled patch change, apply a new patch and start the cycle over (3 weeks wearing a weekly patch, 1 week off). Do not use extra patches to make up the missed dose.

Missing a dose increases your risk of becoming pregnant and you may need to use back-up birth control. If you miss a period for 2 months in a row, call your doctor because you might be pregnant.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using ethinyl estradiol and norelgestromin transdermal?

Do not smoke while using ethinyl estradiol and norelgestromin transdermal, especially if you are older than 35 years of age.

Grapefruit and grapefruit juice may interact with this medicine and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Avoid using creams, lotions, powders, or other medications on the skin where you apply the patch, or it may not stick to your skin.

This medicine will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Ethinyl estradiol and norelgestromin transdermal side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Remove the skin patch and call your doctor at once if you have:

  • signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

  • liver problems--loss of appetite, upper stomach pain, tiredness, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • increased blood pressure--severe headache, blurred vision, pounding in your neck or ears;

  • a change in the pattern or severity of migraine headaches;

  • swelling in your hands, ankles, or feet;

  • a breast lump; or

  • symptoms of depression--sleep problems, weakness, tired feeling, mood changes.

Common side effects may include:

  • breast tenderness;

  • darkening of facial skin;

  • nausea, vomiting;

  • headache;

  • breakthrough bleeding;

  • skin irritation, redness, itching, or swelling where the patch was worn;

  • menstrual cramps; or

  • anxiety, mood changes.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Ethinyl estradiol and norelgestromin dosing information

Usual Adult Dose for Contraception:

Apply 1 new patch each week for 3 weeks (21 days total) topically followed by 1 week that is patch-free

Comments:
-Withdrawal bleeding will usually occur during the 1 week patch-free time period.
-Every new patch should be applied on the same day of the week known as the "patch change day."
-May be less effective in preventing pregnancy in women weighing 90 kg or more.
-May be placed on the upper outer arm, abdomen, buttock, or back in a place where it won't be rubbed by tight clothing.
-Not to be placed on the breasts, on cut or irritated skin, or on the same location as the previous patch.

Usual Pediatric Dose for Contraception:

Apply 1 new patch each week for 3 weeks (21 days total) topically followed by 1 week that is patch-free

Comments:
-Withdrawal bleeding will usually occur during the 1 week patch-free time period.
-Every new patch should be applied on the same day of the week known as the "patch change day."
-May be less effective in preventing pregnancy in women weighing 90 kg or more.
-May be placed on the upper outer arm, abdomen, buttock, or back in a place where it won't be rubbed by tight clothing.
-Not to be placed on the breasts, on cut or irritated skin, or on the same location as the previous patch.

What other drugs will affect ethinyl estradiol and norelgestromin transdermal?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • acetaminophen, ascorbic acid (vitamin C);

  • lamotrigine;

  • levothyroxine or other thyroid medication;

  • antifungal medicine--fluconazole, itraconazole, ketoconazole, voriconazole;

  • cholesterol-lowering medicines--atorvastatin, rosuvastatin; or

  • HIV or AIDS medicines--atazanavir, etravirine, indinavir.

This list is not complete. Other drugs may interact with hormonal birth control, including prescription and over-the-counter medicines, vitamins, and herbal products. Some drugs can make birth control pills less effective, which may result in pregnancy. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about ethinyl estradiol and norelgestromin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 11.01.

Date modified: November 15, 2017
Last reviewed: October 16, 2017

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